Maternal Child Assignment Inward Mom and Baby1
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Feb 20, 2024
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Inward Mom and Baby Questions – Breastfeeding
1.
Winnifred asks how often she can expect her baby to breastfeed over the next few days. How would you reply?
Newborns who are breastfed feed at least 8 to 12 times a day; in the first few weeks, they typically signal hunger by needing to eat every 1.5 to 3 hours.
2.
What suggestions would you offer, to support the development of adequate milk supply?
Milk is produced on a supply-and-demand basis, with the more milk being removed, the more milk the breast will make. Given this supply-and-demand process, a mother can produce enough milk for twins or multiples, as the more milk removed, the more milk the breast will make. Very little milk is stored in the breast between feedings; most is manufactured as the newborn breastfeeds. Also, supplementing feedings with liquids other than the mother’s milk can impact this supply-and-demand system and the body’s ability to determine the amount of milk needed for the baby.
3.
Winnifred has been encouraged to attempt hand expression, but is unsure as to how to do this. What teaching would you provide?
I would teach the mother to do the following:
•
Perform hand hygiene.
•
Get into a comfortable position.
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Gently massage breast and nipple to stimulate let-down reflex.
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Place four fingers supporting lower part of the breast and thumb on top at outer edge of the areola, in the shape of the letter C.
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Push thumb and fingers back toward chest and squeeze fingers and thumb together.
•
Press and release, moving fingers around the areola in a circle to express from different parts.
•
Catch milk in a clean cup, bowl, or jar.
•
Switch between breasts every few minutes.
4.
Identify some breastfeeding positions, and principles to keep in mind, while supporting Winnifred in breastfeeding her baby boy.
Mothers can breastfeed in a variety of positions that may work well for them and their infant,
which include the cradle hold, football (clutch) hold, cross-cradle, and side-lying position.
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The cross-cradle provides good head control and allows the mother to have more control and easily bring the newborn to the breast. -
The football hold, also called the clutch hold, can be used for smaller babies and mothers who have had a Caesarean birth, as there is good head control and less pressure on the mother’s incision. -
The side-lying hold can help the mother rest while feeding, and the classic hold can seem like a familiar hold to support the infant in. -
These last two positions do not allow the mother to control the head and latch as well and
may be used more comfortably once the newborn is older and able to latch on effectively and comfortably.
Some general principles to keep in mind are as follows:
1. The mother should perform hand hygiene before each breastfeeding session.
2. The newborn’s body should be in “chest-to-chest” position with the mother, with the head
and neck in alignment facing the mother.
3. The newborn should be brought to the normal resting level of the breast nipple to allow for comfort and easy flow of milk. The mother should bring the newborn to the breast and not bring the breast to her newborn. The mother should feel comfortable supporting the newborn’s weight in her arms; pillows can be used to help support the mother’s arm and bring the baby to the level of the breast, if needed.
4. Lining the newborn up so that their nose aligns with the nipple will enable the newborn to
take in a big mouthful of breast tissue below the nipple and aim the nipple to the back of the newborn’s mouth. When the newborn’s mouth is wide open before latch-on, a more effective latch-on will occur as the mother moves her arm to bring the newborn’s chin in close to the breast.
5. In preparing for the breastfeed, if the mother has flat or inverted nipples, manually stimulating the nipple may draw it out and make it easier for the infant to latch on. As well, expressing a few drops of colostrum may increase the newborn’s interest in feeding.
6. Alternating the breast that the feeding begins on will ensure both breasts are stimulated equally when the newborn is most hungry. This will assist in having a similar milk supply in
each breast.
7. If the mother is going to support her breast, she should support her breast in a “C position,” with the thumb above the nipple and the fingers below it. The thumb and fingers should be well back, away from the nipple, and the nipple should not tip upward. This will enable the newborn to take a big mouthful of breast tissue, without the hand getting in the way. The hand should be holding the breast gently and not putting pressure on the breast
tissue as this could block the flow of milk and lead to a blocked duct. Mothers with larger breasts may need to provide support to the breast.
8. The mother should watch the newborn’s hunger cues and begin the feeds with early cues and not wait until the newborn is crying and frantic, as this is a late cue. Mothers should be advised to watch the baby, not the clock.
5.
If you have concerns regarding the establishment of breastfeeding upon discharge, what are some resources/agencies you can refer the family to?
The Baby-Friendly Hospital Initiative (BFI) was launched in 1991 by UNICEF and the World Health Association (WHO) with a goal of supporting, protecting, and promoting breastfeeding. A baby-friendly hospital is defined as a facility that meets specific criteria and has been recognized to have met the recently revised 10 steps to successful breastfeeding. The Breastfeeding Committee for Canada (BCC) works with organizations in Canada to become BFI designated and adhere to the International Code for Marketing Breast-milk Substitutes. The BFI has demonstrated a 244 positive impact on breastfeeding initiation and exclusivity in developed and developing countries (RNAO, 2018).
Or following websites:
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A prenatal on-line program: A new prenatal life. (Includes a breastfeeding component). www.anewprenatallife.ca/home
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Baby Friendly Newfoundland and Labrador. www.babyfriendlynl.ca
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INFACT Canada (Infant Feeding Action Coalition to protect, promote and support breastfeeding) www.infactcanada.ca
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INFACT Québec www.infactquebec.org/eng
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Inward Mom and Baby Questions – Newborn Weight
1.
Identify the normal range of a newborn’s weight in grams.
2500 grams – 4000 grams
5 lb 8 oz – 8 lb 13 oz
2.
What do the abbreviations LGA and SGA mean? What criteria is used to determine
this?
SGA: small for gestational age
LGA: large for gestational age
Criteria are used to determine LGA and SGA are gestational age and level of maturation which including weight and size
3.
What is the expected weight loss of a newborn during the first week of life (5-7 days)? At what point does the nurse intervene?
In the first week of life, the infant may lose up to 7 to 10% of the birth weight. This may result from withdrawal from maternal hormones, fluid shifts, and the loss of feces and urine
If weight loss is more than 10%, the newborn feeding needs to be assessed more thoroughly or nurse intervention required.
4.
A newborn weighs 2850 grams at birth. The newborn now weighs 2641 grams. The baby is wearing a security tag weighing 11 grams. Calculate the percentage of weight loss. Determine the significance of your finding. Convert the baby’s weight to kilograms.
The % weight loss is 6.95 %, which is normal weight loss of newborn during the first week of life. Convert the baby’s weight to kilograms:
Newborn weight at birth: 2.85 kilograms
Newborn weight now: 2.64 kilograms
5.
A newborn weighs 3652 grams at birth. The newborn now weighs 3 539 grams. The baby is not wearing a security tag. Calculate the percentage of weight loss. Determine the significance of your finding. Convert the baby’s weight to kilograms.
The % weight loss is 3.09 %, which is normal % weight loss of newborn during the first week of life. Convert the baby’s weight to kilograms:
Newborn weight at birth: 3.65 kilograms
Newborn weight now: 3.54 kilograms
453.592 grams = 1 pound 1 pound =16 ounces
Inward Mom and Baby Questions – Lochia & Clots
1.
What are the three types of lochia and how long would you expect each to last? Provide a brief description of each type, and how they differ.
Three types of lochia are: rubra, serosa, and alba.
Lochia rubra is red because it is composed mostly of blood; it may contain small clots and lasts for about 3 to 4 days after birth.
Lochia serosa is pinkish or brown because it consists of old blood, serum, leukocytes, and
tissue debris. It lasts from about the third through the tenth day after birth, although it can
last up to 25 days.
Lochia alba is mostly mucus and is yellow or white. It usually starts around the tenth day and can last up to 4 to 6 weeks after birth.
2.
What is the normal amount of lochia expected during the 1
st
2-3 postpartum days? The normal amount of lochia expected during the first 2-3 postpartum days is no more than one saturated pad per hour.
3.
What amount of lochia is considered problematic during this time frame?
If the amount of lochia is more than one saturated pad per hour, it is considered problematic.
4.
What must you ask clients before assessing the amount of lochia?
Ask the client the last time they changed the perineal pad.
5.
What activities may cause a normal increase in the amount of lochia?
The flow of lochia is briefly heavier when the mother ambulates, because lochia pooled in the vagina is discharged when she assumes an upright position. A few small clots may be seen at this
time, but large clots should not be present. The quantity of lochia may briefly increase when the mother breastfeeds because suckling causes
uterine contraction. The rate of discharge increases with exercise.
6.
What size of clot requires further investigation?
If size of clots larger than a golf ball, it will require further investigation.
References:
Public Health Agency of Canada. (2019, December 4). Protecting, Promoting And Supporting Breastfeeding: A Practical Workbook For Community-based Programs - 2nd Edition
. Canada.ca. https://www.canada.ca/en/public-health/services/health-promotion/childhood-
adolescence/publications/protecting-promoting-supporting-breastfeeding.html
Leifer, G., & KeenanLindsay, L. (2020). Leifer's Introduction to Maternity & Pediatric Nursing in Canada. Elsevier Health Sciences (US). https://pageburstls.elsevier.com/books/9781771722049
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